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Eyelash Extensions Service Consent Form for COVID-19


Due to the 2019-2020 outbreaks of the novel Coronavirus COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.

I, ________________________(Client’s Name), confirm that I am not presenting any of the following symptoms of COVID-19 listed below:

Fever, Shortness of breath, loss of taste or smell, dry cough, running nose, sore throat.

I agree to the following:

  • I understand the above symptoms and affirm that I, as well as household members, do not currently have, nor have experienced the symptoms listed above within the 14 days.

  • I affirm that I, as well as household members, have not been diagnosed with COIVD-19 within the last 30 days.

  • I understand the COVID-19 virus has a ling incubation period during which carriers of the virus may not show symptoms & still be highly contagious.

  • I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristic of these services that I have an elevated risk of contacting the virus simply by being in the establishment.

  • To prevent the spread of the contagious virus and to help protect each other, I understand that I must follow the establishment’s guidelines.

  • Reschedule appointment if you are feeling unwell.

  • No additional guest is allowed.

  • Wearing a mask is required upon arrival and during the entire procedure.

  • Wash hands upon arrival.

  • Limit conversation during the procedure.

I, knowing and willing consent to have eyelash extension service during the pandemic and will not hold ___________________ (Salon Name) or anyone working for this establishment, liable for the possibility of contacting COVID-19.


Client Signature ________________________

Date: _________________

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